Surgical instruments for tensioning tissue

ABSTRACT

An end effector including a first jaw, a second jaw, a longitudinal slot, and a cutting member is disclosed. The first jaw includes a first lateral side and a second lateral side. At least one of the first jaw and the second jaw is moveable through a range of positions to move the end effector between an open configuration and a fully clamped configuration. The longitudinal slot extends intermediate a proximal portion and a distal portion. The longitudinal slot transects the first jaw between the first lateral side and the second lateral side and extends distally beyond a portion of the second jaw. The cutting member is movable along the longitudinal slot. The first jaw is expandable laterally relative to the longitudinal slot to apply a tensile force to tissue clamped between the first jaw and the second jaw when the end effector is in the fully clamped configuration.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation application claiming priority under35 U.S.C. § 120 to U.S. patent application Ser. No. 13/189,169, entitledSURGICAL INSTRUMENTS FOR TENSIONING TISSUE, filed Jul. 22, 2011, whichissued on Feb. 16, 2016 as U.S. Pat. No. 9,259,265, the entiredisclosure of which is hereby incorporated by reference herein.

FIELD

The present disclosure relates generally to surgical instrumentssuitable for sealing tissue and, more particularly, relates to surgicalinstruments comprising an electrode and configured to tension tissueadjacent tissue being sealed by the electrode.

BACKGROUND

In various open, endoscopic, and/or laparoscopic surgeries, for example,it may be desirable to coagulate, seal, and/or fuse tissue. One methodof sealing tissue relies upon the application of energy, such aselectrical energy, for example, to tissue captured or clamped within anend-effector or an end-effector assembly of a surgical instrument inorder to cause thermal effects within the tissue. Various mono-polar andbi-polar radio frequency (Rf) surgical instruments and surgicaltechniques have been developed for such purposes. In general, thedelivery of Rf energy to the captured tissue can elevate the temperatureof the tissue and, as a result, the energy can at least partiallydenature proteins within the tissue. Such proteins, such as collagen,for example, can be denatured into a proteinaceous amalgam thatintermixes and fuses, or seals, together as the proteins renature. Asthe treated region heals over time, this biological seal may bereabsorbed by the body's wound healing process.

In certain arrangements of a bi-polar radiofrequency (Rf) surgicalinstrument, the surgical instrument can comprise opposing first andsecond jaws, wherein each jaw can comprise an electrode. In use, thetissue can be captured between the jaws such that energy can flowbetween the electrodes in the opposing jaws and through the tissuepositioned therebetween. Such instruments may have to seal many types oftissues, such as anatomic structures having walls with irregular orthick fibrous content, bundles of disparate anatomic structures,substantially thick anatomic structures, and/or tissues with thickfascia layers such as large diameter blood vessels, for example. Withparticular regard to sealing large diameter blood vessels, for example,such applications may require a high strength tissue seal immediatelypost-treatment.

The foregoing discussion is intended only to illustrate various aspectsof the related art and should not be taken as a disavowal of claimscope.

SUMMARY

In one non-limiting example, the present disclosure, in part, isdirected to an end effector including a first jaw, a second jaw, aproximal portion, a distal portion, a longitudinal slot, and a cuttingmember. The first jaw includes a first lateral side and a second lateralside. At least one of the first jaw and the second jaw is moveablethrough a range of positions to move the end effector between an openconfiguration and a fully clamped configuration. The longitudinal slotextends intermediate the proximal portion and the distal portion. Thelongitudinal slot transects the first jaw between the first lateral sideand the second lateral side and extends distally beyond a portion of thesecond jaw. The cutting member is movable along the longitudinal slot.The first jaw is expandable laterally relative to the longitudinal slotto apply a tensile force to tissue clamped between the first jaw and thesecond jaw when the end effector is in the fully clamped configuration.

In one non-limiting example, the present disclosure, in part, isdirected to an end effector including a first jaw, a second jaw, alongitudinal slot, and a cutting member. The first jaw includes a firstlateral side, a second lateral side, and a first width definedintermediate the first lateral side and the second lateral side. Thesecond jaw includes a second width. At least one of the first jaw andthe second jaw is moveable through a range of positions to move the endeffector between an open configuration and a fully clampedconfiguration. The longitudinal slot transects the first jaw between thefirst lateral side and the second lateral side and extends distallybeyond a portion of the second jaw. The cutting member is movable alongthe longitudinal slot. The first width of the first jaw and the secondwidth of the second jaw are adaptable to adjust a force applied totissue clamped between the first jaw and the second jaw when the endeffector is in the fully clamped configuration.

In one non-limiting example, the present disclosure, in part, isdirected to an end effector including a first jaw, a second jaw, alongitudinal slot, and a cutting member. The first jaw includes a width,a first lateral side, and a second lateral side. At least one of thefirst jaw and the second jaw is moveable through a range of positions tomove the end effector between an open configuration and a fully clampedconfiguration. The longitudinal slot transects the first jaw between thefirst lateral side and the second lateral side and extends distallybeyond a portion of the second jaw. The cutting member is movable alongthe longitudinal slot. The width of the first jaw is configured tochange to adjust a pressure in tissue clamped between the first jaw andthe second jaw when the end effector is in the fully clampedconfiguration.

BRIEF DESCRIPTION OF THE DRAWINGS

Various features of the embodiments described herein are set forth withparticularity in the appended claims. The various embodiments, however,both as to organization and methods of operation, together with theadvantages thereof, may be understood in accordance with the followingdescription taken in conjunction with the accompanying drawings asfollows.

FIG. 1 is a side view of a surgical instrument in accordance with atleast one non-limiting embodiment of the present disclosure;

FIG. 2 is an enlarged side view of an end-effector of the surgicalinstrument of FIG. 1 in accordance with at least one non-limitingembodiment of the present disclosure;

FIG. 2A is an exploded perspective view of the end-effector of FIG. 2 inaccordance with at least one non-limiting embodiment of the presentdisclosure;

FIGS. 3, 3A, and 4 are perspective views of an end-effector of asurgical instrument engaging tissue in accordance with at least onenon-limiting embodiment of the present disclosure;

FIG. 4A is a detail view of the indicated portion of FIG. 4 inaccordance with one non-limiting embodiment of the present disclosure;

FIG. 5 is partial cut-away perspective view of an end-effector of asurgical instrument engaging tissue in accordance with at least onenon-limiting embodiment of the present disclosure;

FIG. 6 is a cross-sectional view of the end-effector of FIG. 3A takenalong line 6-6 in accordance with at least one non-limiting embodimentof the present disclosure;

FIG. 6A is a cross-sectional view of the end-effector of FIG. 4 takenalong line 6A-6A in accordance with at least one non-limiting embodimentof the present disclosure;

FIG. 7 is a schematic illustration of portions of an end-effectorengaging tissue in a first, unextended position in accordance with atleast one non-limiting embodiment of the present disclosure;

FIG. 8 is a schematic illustration of the portions of the end-effectorof FIG. 7 engaging tissue in a second, extended position in accordancewith one non-limiting embodiment of the present disclosure;

FIG. 9 is a schematic illustration of the portion of the end-effector ofFIG. 8 when energy is applied to one or more electrodes within theend-effector in accordance with at least one non-limiting embodiment ofthe present disclosure;

FIG. 10 is a schematic illustration of the tissue illustrated in FIG. 9after the tissue has been sealed, tensioned, and incised in accordancewith at least one non-limiting embodiment of the present disclosure;

FIG. 11 is a perspective view of an end-effector and a portion of asurgical instrument in accordance with at least one non-limitingembodiment of the present disclosure;

FIG. 12 is an exploded perspective view of the end-effector of FIG. 11in accordance with at least one non-limiting embodiment of the presentdisclosure;

FIGS. 13A-13D illustrate the operation of a surgical instrument inaccordance with at least one non-limiting embodiment of the presentdisclosure;

FIG. 14A is a cross-sectional view of an end-effector in accordance withat least one non-limiting embodiment of the present disclosure;

FIG. 14B is a cross-sectional view of the end-effector of FIG. 14A in aclosed and extended position in accordance with at least onenon-limiting embodiment of the present disclosure;

FIGS. 15A-15B illustrate the movement of portions of the end-effector ofFIGS. 13A-13D;

FIGS. 16A-16B illustrate the movement of portions of the end-effector ofFIGS. 11 and 12; and

FIG. 17 is a side view of an end-effector comprising tissue-grippingportions in accordance with at least one non-limiting embodiment of thepresent disclosure.

Corresponding reference characters indicate corresponding partsthroughout the several views. The example embodiments set out hereinillustrate various embodiments of the present disclosure, in one form,and such example embodiments are not to be construed as limiting thescope of the present disclosure in any manner.

DETAILED DESCRIPTION

Various embodiments are directed to apparatuses, systems, and methodsfor the treatment of tissue. Numerous specific details are set forth toprovide a thorough understanding of the overall structure, function,manufacture, and use of the embodiments as described in thespecification and illustrated in the accompanying drawings. It will beunderstood by those skilled in the art, however, that the embodimentsmay be practiced without such specific details. In other instances,well-known operations, components, and elements have not been describedin detail so as not to obscure the embodiments described in thespecification. Those of ordinary skill in the art will understand thatthe embodiments described and illustrated herein are non-limitingexamples, and thus it can be appreciated that the specific structuraland functional details disclosed herein may be representative andillustrative. Variations and changes thereto may be made withoutdeparting from the scope of the claims.

Reference throughout the specification to “various embodiments,” “someembodiments,” “one embodiment,” “certain embodiments,” or “in anembodiment”, or the like, means that a particular feature, structure, orcharacteristic described in connection with the embodiment is includedin at least one embodiment. Thus, appearances of the phrases “in variousembodiments,” “in some embodiments,” “in one embodiment,” “in certainembodiments,” or “in an embodiment”, or the like, in places throughoutthe specification are not necessarily all referring to the sameembodiment. Furthermore, the particular features, structures, orcharacteristics may be combined in any suitable manner in one or moreembodiments. Thus, the particular features, structures, orcharacteristics illustrated or described in connection with oneembodiment may be combined, in whole or in part, with the featuresstructures, or characteristics of one or more other embodiments withoutlimitation.

The entire disclosures of the following non-provisional United Statespatents are hereby incorporated by reference herein:

U.S. Pat. No. 7,381,209, entitled ELECTROSURGICAL INSTRUMENT;

U.S. Pat. No. 7,354,440, entitled ELECTROSURGICAL INSTRUMENT AND METHODOF USE;

U.S. Pat. No. 7,311,709, entitled ELECTROSURGICAL INSTRUMENT AND METHODOF USE;

U.S. Pat. No. 7,309,849, entitled POLYMER COMPOSITIONS EXHIBITING A PTCPROPERTY AND METHODS OF FABRICATION;

U.S. Pat. No. 7,220,951, entitled SURGICAL SEALING SURFACES AND METHODSOF USE;

U.S. Pat. No. 7,189,233, entitled ELECTROSURGICAL INSTRUMENT;

U.S. Pat. No. 7,186,253, entitled ELECTROSURGICAL JAW STRUCTURE FORCONTROLLED ENERGY DELIVERY;

U.S. Pat. No. 7,169,146, entitled ELECTROSURGICAL PROBE AND METHOD OFUSE;

U.S. Pat. No. 7,125,409, entitled ELECTROSURGICAL WORKING END FORCONTROLLED ENERGY DELIVERY; and

U.S. Pat. No. 7,112,201, entitled ELECTROSURGICAL INSTRUMENT AND METHODOF USE.

Various embodiments of systems and methods of the present disclosurerelate to creating thermal “welds”, “seals” and/or “fusion” withinnative tissue volumes, which are indicated in the figures as “Ti”. Theseterms may be used interchangeably herein to describe thermal treatmentsof a targeted tissue volume that can result in a substantially uniformfused-together tissue mass, for example, in welding blood vessels thatexhibit substantial burst strength immediately post-treatment. Thestrength of such welds is particularly useful for (i) permanentlysealing blood vessels in vessel transection procedures; (ii) weldingorgan margins in resection procedures; (iii) welding other anatomicducts wherein permanent closure is required; and also (iv) forperforming vessel anastomosis, vessel closure, and/or other proceduresthat join together anatomic structures or portions thereof. The sealing,welding, and/or fusion of tissue as disclosed herein is to bedistinguished from “coagulation”, “hemostasis” and other similardescriptive terms that generally relate to the collapse and occlusion ofblood flow within small blood vessels or vascularized tissue. Forexample, any surface application of thermal energy can cause coagulationor hemostasis—but does not fall into the category of “sealing” as theterm is used herein. Such surface coagulation may not create a seal thatprovides any substantial strength in the treated tissue.

At the molecular level, the phenomena of truly “sealing” tissue asdisclosed herein may result from the thermally-induced denaturation ofcollagen and/or other protein molecules in a targeted tissue volume tocreate a transient liquid or gel-like proteinaceous amalgam. In variouscircumstances, a selected energy density can be provided in the targetedtissue to cause hydrothermal breakdown of intra- and intermolecularhydrogen crosslinks in the collagen and/or other protein molecules. Thedenatured amalgam can be maintained at a selected level ofhydration—without desiccation—for a selected time interval which can bevery brief. In various embodiments, the targeted tissue volume can bemaintained under a selected high level of mechanical compression toinsure that the unwound strands of the denatured proteins are in closeproximity to one another to allow their re-intertwining andre-entanglement. Upon the thermal relaxation, or cooling, of the tissue,the intermixed amalgam can result in protein entanglement asre-crosslinking or renaturation occurs to thereby cause a uniformfused-together mass.

Further to the above, the thermally-induced denaturation of collagenand/or other protein molecules described above can, in variouscircumstances, result in permanent changes to the tissue. In certaincircumstances, the tissue can be heated in a manner which allows thecollagen molecules to permanently unwind and damage the tissue. In atleast some such circumstances, the amount of damage done to the tissuecan be measured by the amount in which the tissue shrinks as a result ofthe thermal energy applied thereto. For example, greatly-damaged tissuemay tend to shrink more than lesser-damaged tissue. Such concepts arediscussed in greater detail in Continuum thermodynamics and the clinicaltreatment of disease and injury, J. D. Humphrey, Appl. Mech. Rev., vol.56, no. 2, March 2003; Heat-induced changes in the mechanics of acollagenous tissue: Isothermal isotonic-shrinkage, Chen, S. S., Wright,N. T., Humphrey, J. D., ASME Journal of Biomechanical Engineering 120,382-388, 1998; and Kinetics of thermal damage to a collagenous membraneunder biaxial isotonic loading, Harris, J. L., Humphrey J. D., IEEETrans. Biomed. Eng. 2004 February, 51(2): 371-9, the entire disclosuresof which are incorporated by reference herein.

In various circumstances, the amount in which the tissue can be damagedby the application of thermal energy thereto can be predicted. Moreparticularly, the denaturation of the collagen within the tissue can bea function of at least two variables such as, one, the temperature towhich the tissue is heated and, two, the time in which the tissue isheated, for example. Stated another way, the denaturation of thecollagen within the tissue can be a function of time and temperature. Itis believed by the Applicants that the degree to which the collagen isdenaturized can also be a function of another variable, i.e., themechanical force applied to the tissue. More particularly, it isbelieved by the Applicants that when a tensile load is applied to thetissue at the same time that the tissue is being exposed to thermalenergy, excessive denaturation of the collagen can be reduced, delayed,and/or possibly prevented. It is believed that the tensioning of thetissue inhibits an undesired amount of unwinding and/or shortening ofthe collagen molecules. Thus, in various circumstances, the damage totissue can be reduced and/or avoided when the tissue is stretched, forexample.

Various embodiments disclosed herein provide electrosurgical jawstructures adapted for transecting captured tissue between the jaws andfor contemporaneously sealing the captured tissue margins withcontrolled application of RF energy or other energy. The jaw structurescan comprise a scoring element which can cut or score tissueindependently of the tissue capturing and sealing functions of the jawstructures. The jaw structures can comprise first and second opposingjaws that carry fuses, such as positive temperature coefficientmaterials (“PTC” materials), for example, for modulating energy deliveryto the engaged tissue.

The embodiments of the devices described herein may be introduced insidea patient using minimally invasive or open surgical techniques underdirect control of a clinician or by way of indirect control of aclinician through the use of robot assistance. In some instances, it maybe advantageous to introduce the devices inside the patient using acombination of minimally invasive and open surgical techniques.Minimally invasive techniques may provide more accurate and effectiveaccess to the treatment region for diagnostic and treatment proceduresand include but are not limited to numerous laparoscopic approachesincluding the use of multiple trocars or ports distributed about thepatient, multiple trocars placed at a single site, and/or a singletrocar with multiple ports placed in a location such as, but not limitedto, the umbilicus, for example. To reach internal treatment regionswithin the patient, the devices described herein may be inserted throughnatural openings of the body such as the mouth, anus, and/or vagina, forexample. Minimally invasive procedures performed by the introduction ofvarious medical devices into the patient through a natural opening ofthe patient are known as Natural Orifice, Transluminal, EndoscopicSurgery or NOTES™ procedures. Some portions of the devices may beintroduced to the tissue treatment region percutaneously or throughsmall—keyhole—incisions.

Endoscopic minimally invasive surgical and diagnostic medical procedurescan be used to evaluate and treat internal organs by inserting a smalltube into the body. The endoscope may have a rigid or a flexible tube. Aflexible endoscope may be introduced either through a natural bodyopening (e.g., mouth, anus, and/or vagina) or via a trocar through arelatively small—keyhole—incision (usually 0.5-1.5 cm). The endoscopecan be used to observe surface conditions of internal organs, includingabnormal or diseased tissue such as lesions and other surface conditionsand capture images for visual inspection and photography. The endoscopemay be adapted and configured with working channels for introducingmedical instruments to the treatment region for taking biopsies,retrieving foreign objects, and/or performing surgical procedures.

Certain example embodiments will now be described to provide an overallunderstanding of the principles of the structure, function, manufacture,and use of the devices and methods disclosed herein. One or moreexamples of these embodiments are illustrated in the accompanyingdrawings. Those of ordinary skill in the art will understand that thedevices and methods specifically described herein and illustrated in theaccompanying drawings are non-limiting example embodiments and that thescope of the various embodiments of the present disclosure is definedsolely by the claims. The features illustrated or described inconnection with one example embodiment may be combined with the featuresof other embodiments. Such modifications and variations are intended tobe included within the scope of the present disclosure.

In various embodiments, referring to FIG. 1, a surgical instrument 10can comprise an elongate shaft 12, a handle portion 14, and anend-effector 16. The end-effector 16 can comprise a proximal endconfigured to be engaged with the shaft 12, a distal end positioneddistal from the shaft 12, and a longitudinal axis defined intermediatethe proximal end and the distal end. The elongate shaft 12 can comprisea proximal end 18 and a distal end 20. The handle portion 14 can extendfrom the proximal end 18 of the elongate shaft 12 and the end-effector16 can extend from the distal end 20 of the elongate shaft 12. The terms“proximal” and “distal” are used herein with reference to the clinicianor surgeon (hereafter “surgeon”) holding the handle portion 14 of thesurgical instrument 10. For example, the end-effector 16 is locateddistal from the surgeon while the handle portion 14 is located proximalto the surgeon. In various embodiments, the handle portion 14 cancomprise two portions which are assembled together to form the handleportion 14, for example. In one embodiment, the two portions of thehandle portion 14 can be snap-fit, press-fit, adhered, glued, and/orotherwise fastened to one another.

In one embodiment, the surgical instrument 10 and portions of theend-effector 16 can be in communication with an energy source 11 throughconductors 15 and 17 such that the jaws or other portions of theend-effector 16 can function as a pair of bi-polar electrodes, forexample, wherein one electrode can have a positive polarity (+) and oneelectrode can have a negative polarity (−), as is discussed in greaterdetail herein. In one embodiment, the conductor 15 can have a positivepolarity and the conductor 17 can have a negative polarity, for example.The conductors 15 and 17 can be in electrical communication with theend-effector 16 and/or other portions of the surgical instrument 10 suchthat energy can be supplied from the energy source 11 to theend-effector 16 or other portions of the surgical instrument 10 throughthe conductors 15 and 17. In one embodiment, the energy source 11 can beconfigured to supply energy, such as electrical energy, RF energy,ultrasonic energy, and/or thermal energy, for example, from the energysource 11 to the tissue compressed within the end-effector 16 to seal orotherwise energize the tissue. The delivery of the energy from theenergy source 11, such as the magnitude, duration, wave form, and/orfrequency, for example, of the energy can be sufficiently controlled ormodulated by a controller 13 to provide a desired amount or type ofenergy to the surgical instrument 10. Although not shown, it isconceived that the energy source, controller, and/or conductors may belocated on and/or within the device (e.g., within handle portion 14).Various suitable energy sources and controllers are known to those ofskill in the art.

In one embodiment, the handle portion 14 can comprise a grip 22including a gripping surface 23, a trigger 24, and an actuation button26 optionally positioned on and/or extending from the trigger 24. Invarious embodiments, the actuation button 26 can be configured as aseparate trigger. In other various embodiments, the actuation button canbe positioned on the handle portion 14, instead of the trigger 24, forexample. In use, as described in greater detail below, the trigger 24can be moved or pivoted proximally toward the grip 22 to actuate and/orclose the end-effector 16 of the surgical instrument 10. In oneembodiment, the handle portion 14 can comprise a rotatable knob 28operably engaged with and/or attached to the proximal end 18 of theelongate shaft 12. In at least one such embodiment, the elongate shaft12 can form a longitudinal axis extending between the proximal end 18and the distal end 20 of the shaft 12 wherein the rotatable knob 28 canallow a surgeon to rotate the end-effector 16 about the longitudinalaxis in the direction indicated by arrow “R” (FIG. 5), for example, inorder to better position the end-effector 16 for various surgicalprocedures. In other embodiments, the end-effector 16 may not berotatable relative to the handle portion 14. In one embodiment, theend-effector 16 can be articulated relative the elongate shaft 12 in anysuitable manner for various surgical procedures.

In one embodiment, referring to FIGS. 1, 2, and 2A, the end-effector 16can comprise a first jaw 30 and a second jaw 32. In various embodiments,the first jaw 30 can comprise an electrode 44 and the second jaw 32 cancomprise an electrode 45 and/or a fuse 33, which can be comprised of aPTC material, for example, as discussed below. In various embodiments,at least one of the first jaw 30 and the second jaw 32 can be configuredto move relative to the other jaw between an open position and a closedposition upon the actuation of the trigger 24. In one embodiment, theopen position of the end effector 16 is illustrated in FIGS. 1, 2, and 3and the closed position of the end effector 16 is illustrated in FIGS.3A, 4, and 5. In various embodiments, only one of the first jaw 30 andthe second jaw 32 may be movable relative to the other jaw while, inother embodiments, the first jaw 30 and the second jaw 32 may both bemovable relative to each other. In either event, the end-effector 16 canengage and compress tissue, or layers of tissue, therewithin when thesecond jaw 32 is moved from an open position into a closed position, forexample. Such movement of the second jaw 32 can help to uniformly, orsubstantially uniformly, compress the tissue and reduce the amount offluids, such as water or blood, for example, contained within the tissuein the area of compressed tissue. In various embodiments, one or both ofthe first jaw 30 and the second jaw 32 can comprise a tissue-grippingportion, or teeth, 34 configured to aid the first jaw 30 and the secondjaw 32 in holding tissue or layers of tissue within the end-effector 16during the closure of the end-effector 16 and/or the cutting and sealingof the tissue, as described below.

In one embodiment, referring to FIGS. 1-4, the trigger 24 can advance amovable member 36 distally within the end-effector 16 when the trigger24 is moved proximally toward the grip 22. In various embodiments, aconduit, bar, or tube 35 can be operably engaged with the trigger 24wherein the tube 35 can extend from the handle portion 14 to theproximal end of the end-effector 16 and/or the distal end 20 of theelongate shaft 12. The tube 35 can be operably engaged with the movablemember 36 and can be used to move the movable member 36 distally and/orproximally within the end-effector 16 and/or the elongate shaft 12. Theactuation mechanisms within the handle portion 14 that can move the tube35 within the elongate shaft 12 and the movable member 36 within theend-effector 16 upon the actuation of the trigger 24 are described ingreater detail in co-pending U.S. patent application Ser. No.12/732,992, entitled SURGICAL CUTTING AND SEALING INSTRUMENT WITHREDUCED FIRING FORCE, filed on Mar. 26, 2010, the disclosure of which isincorporated by reference herein in its entirety. In one embodiment, themovable member 36 can comprise an I-beam or E-beam configuration and cancomprise one or more fins 37 extending therefrom configured to engagethe first jaw 30 and the second jaw 32 and move, or pivot, the first andsecond jaws 30 and 32 into the closed position when the movable member36 is advanced distally within the end-effector 16. In one embodiment,the progression of the movable member 36 and the closure of the firstand second jaws 30 and 32 is illustrated in FIGS. 3 and 3A. In oneembodiment, such a closure mechanism can provide substantially equaltissue compression in tissue of substantially the same thickness. Invarious embodiments, referring primarily to FIG. 2A, the movable member36 can comprise or can be attached to a cutting member, or knife edge,38 configured to cut tissue positioned within the end-effector 16. Themovable member 36 can also comprise one or more cams or camming surfaces40 positioned proximate to the distal end thereof which are configuredto bias portions of the first jaw 30 and the second jaw 32 laterally, asdescribed in further detail herein.

In one embodiment, referring to FIGS. 2A-4, 5, 6, and 6A, the first jaw30 can comprise a base 42 including a gripping portion 34 configured togrip tissue, an electrode 44 in electrical communication with aconductive element 46, a support member 48 configured to support theelectrode 44, a first slider member 50, a third slider member 66, and abiasing member, or spring element, 56. The conductive element 46 canextend into the elongate shaft 12 and can be in electrical communicationwith the conductor 15, for example, such that current can flow betweenthe electrode 44 and the conductor 15 during use. In certainembodiments, the electrode 44 can be press-fit, snap fit, and/orotherwise engaged within a channel 58 (FIG. 2A) of the support member 48wherein, in at least one embodiment, relative movement between theelectrode 44 and the support member 48 can be prevented, or at leastlimited. In various embodiments, a first end of the electrode 44 can bepositioned proximate to the distal end 20 of the elongate shaft 12 and asecond end of the electrode 44 can be positioned distally with respectto the distal end 20 of the elongate shaft 12. In at least one suchembodiment, an axis can be defined between the first end of theelectrode 44 and the second end of the electrode 44. In certainembodiments, the electrode 44 can comprise a U-shaped configuration, forexample. In various embodiments, the first jaw 30 can comprise more thanone electrode. Regardless of the shape and/or quantity of electrodesengaged with the support member 48, for example, the support member 48,and the electrodes attached thereto, can be snap-fit, press-fit, and/orotherwise engaged with the base 42. In one embodiment, atissue-contacting surface 59 on the support member 48 can be comprisedof an insulative and/or non-conductive material that can surround theelectrode 44 such that energy supplied to the electrode 44, or at leasta substantial portion of the energy supplied to the electrode 44, mayflow from the electrode 44 to the second jaw 32. Other suitable portionsof the first jaw 30 can be comprised of insulative and/or non-conductivematerials as well such that a desired flow of energy through theend-effector 16 can be achieved.

In various embodiments, further to the above, the first slider member 50and the third slider member 66 can be slidably attached to the base 42of the first jaw 30. In at least one embodiment, the biasing member 56can connect the distal end of the first slider member 50 and the distalend of the third slider member 66 to the distal end of the base 42. Inat least one such embodiment, the biasing member 56 can comprise a baseportion which is embedded within and/or otherwise attached to the base42 and, in addition, two ends extending therefrom wherein one of theends can be engaged with the first slider member 50 and the other endcan be engaged with the second slider member 66. In various embodiments,the biasing member 56 can be configured to resiliently bias the firstand third slider members 50 and 66 inwardly toward a longitudinal axis,or center, of the end-effector 16. In order to move the first and thirdslider members 50 and 66 outwardly, as described in greater detailbelow, the movable member 36 can engage the first and third slidermembers 50 and 66 and displace them outwardly. In at least one suchembodiment, the cams 40 extending from the movable member 36 can engagethe proximal ends of the first and third slider members 50 and 66 todisplace the slider members 50 and 66 outwardly away from thelongitudinal axis when the movable member 36 is advanced into the endeffector 16. In use, the fins 37 of the movable member 36 can engage thesecond jaw 32 and pivot the second jaw 32 into a closed position priorto the cams 40 contacting the slider members 50 and 66. In at least onesuch embodiment, as a result, the slider members 50 and 66 would bemoved outwardly after the second jaw 32 has been closed. In suchembodiments, at least a portion of the fins 37 can lead, or bepositioned distally, with respect to the cams 40. In certainembodiments, the fins 37 can engage the jaw 32 at the same time that thecams 40 contact the slider members 50 and 66. In at least one suchembodiment, as a result, the slider members 50 and 66 would be movedoutwardly at the same time that the second jaw 32 is closed. In eitherevent, the first and third slider members 50 and 66 can be configured tobe moved relative to and/or away from the electrode 44, relative toand/or away from a longitudinal axis of the end-effector 16, and/orrelative to and/or away from the base 42.

In various embodiments, the base 42 of the first jaw 30 can comprise atleast one first guide rail configured to guide the first slider member50 along a predetermined path. In at least one such embodiment, thefirst slider member 50 can comprise at least one first channel or guideslot configured to slidably receive the first guide rail therein. Inuse, the first guide rail and the first guide slot can co-operate tolimit the movement of the first slider member 50 such that the firstslider member 50 moves laterally when it is displaced. Further to theabove, the base 42 of the first jaw 30 can further comprise at least onethird guide rail configured to guide the third slider member 66 along apredetermined path. In at least one such embodiment, the third slidermember 66 can comprise at least one third channel or guide slotconfigured to slidably receive the third guide rail therein. In use, thethird guide rail and the third guide slot can co-operate to limit themovement of the third slider member 66 such that the third slider member66 moves laterally when it is displaced.

In various embodiments, as described above, the movable member 36 cancomprise a cutting member, or knife edge, 38, for example, which cantransect the tissue captured between the first jaw 30 and the second jaw32 as the movable member 36 is advanced through the end-effector 16. Incertain embodiments, further to the above, the knife edge 38 can lag thefront, or leading, edge of the fins 37 such that the knife edge 38 maynot contact the tissue until the second jaw 32 is in its closedposition. In at least one such embodiment, the knife edge 38 may alsolag the cams 40 such that the knife edge 38 may not contact the tissueuntil the slider members 50 and 66 have been displaced laterally. Incertain embodiments, a surgical instrument can comprise a cutting memberwhich is movable independently of the movable member 36. In at least onesuch embodiment, the movable member 36 can comprise fins 37 and cams 40,for example, which can close the second jaw 32 and displace the slidermembers 50 and 66, respectively, wherein a separate cutting member canbe advanced distally at any suitable point during the operation of theinstrument. In various embodiments, the surgical instrument can comprisea lock which can be configured to prevent the distal motion of thecutting member until the slider members 50 and 66 have been displacedlaterally, for example. Regardless of when the cutting member isadvanced to transect the tissue, in various embodiments, the first jaw30 can also comprise a cutting member slot 60 configured to receive aportion of the cutting member 38 therein.

In one embodiment, referring now to FIGS. 2A-4, 5, 6, and 6A, the secondjaw 32 can comprise a carrying member, or frame, 47, the fuse 33, whichcan be comprised of a PTC material, the electrode 45, a second slidermember 52, a fourth slider member 68, a retaining clip 54, a biasingmember, or spring element, 56′, and a support portion 57. In variousembodiments, the electrode 45 can be mounted to the carrying member 47and the retaining clip 54 can be used to attach the carrying member 47and the electrode 45 to the support portion 57 of the second jaw 32.Similar to the above, the second slider member 52 and the fourth slidermember 68 can be slidably attached to the support portion 57. In atleast one embodiment, the biasing member 56′ can comprise a base portionmounted to the support portion 57 of the second jaw 32 and two endsextending from the base portion. A first end of the biasing member 56′can be engaged with the second slider member 52 and a second end of thebiasing member 56′ can be engaged with the fourth slider member 68wherein the biasing member 56′ can be configured to bias the second andfourth slider members 52 and 68 inwardly toward the longitudinal axis,or center, of the end-effector 16 and/or toward a longitudinal axis ofthe electrode 45. In use, similar to the above, the cams 40 extendingfrom the movable member 36 can engage the proximal ends of the secondand fourth slider members 52 and 68 and displace the second and fourthslider members 52 and 68 outwardly. In various embodiments, the secondand fourth slider members 52 and 68 can be configured to be movedrelative to and/or away from the electrode 45, relative to and/or awayfrom the longitudinal axis of the end-effector 16, and/or relative toand/or away from the support portion 57. Similar to the above, thesecond jaw 32 can also comprise a cutting member slot 60′ configured toreceive a portion of the cutting member 38.

In various embodiments, the support portion 57 of the second jaw 32 cancomprise at least one second guide rail configured to guide the secondslider member 52 along a predetermined path. In at least one suchembodiment, the second slider member 52 can comprise at least one secondchannel or guide slot configured to slidably receive the second guiderail therein. In use, the second guide rail and the second guide slotcan co-operate to limit the movement of the second slider member 52 suchthat the second slider member 52 moves laterally when it is displaced.Further to the above, the support portion 57 of the second jaw 32 canfurther comprise at least one fourth guide rail configured to guide thefourth slider member 68 along a predetermined path. In at least one suchembodiment, the fourth slider member 68 can comprise at least one fourthchannel or guide slot configured to slidably receive the fourth guiderail therein. In use, the fourth guide rail and the fourth guide slotcan co-operate to limit the movement of the fourth slider member 68 suchthat the fourth slider member 68 moves laterally when it is displaced.

As described above, the cams 40 extending from the movable member 36 candisplace the first slider member 50, the second slider member 52, thethird slider member 66, and the fourth slider member 68 laterally, oroutwardly, away from the longitudinal center of the first jaw 30 and thesecond jaw 32. In various embodiments, the cams 40 can engage the slidermembers 50, 52, 66, and 68 simultaneously, or at least substantiallysimultaneously, and displace the slider members 50, 52, 66, and 68 atthe same time. In such embodiments, further to the below, the firstslider member 50 and the second slider member 52 can comprise a firstpair of slider members which can tension tissue in a first direction andthe third slider member 66 and the fourth slider member 68 can comprisea second pair of slider members which can tension tissue in a seconddirection, which can be opposite the first direction, for example. In atleast one such embodiment, the first pair of slider members 50 and 52and the second pair of slider members 66 and 68 can pull in the tissuein different directions at the same time. In various other embodiments,the slider members 50, 52, 66, and/or 68 can be displaced sequentially.In at least one such embodiment, the first pair of slider members 50 and52 can be displaced laterally before the second pair of slider members66 and 68 are displaced laterally, for example. In certain embodiments,the cams 40 can be positioned on the movable member such that the cams40 that engage the third slider member 66 and the fourth slider member68 are staggered proximally behind the cams 40 that engage the firstslider member 50 and the second slider member 52.

In at least one embodiment, referring to FIGS. 2A-4, 5, 6, and 6A, thesurgical instrument can further comprise a first guide 62 which can bepositioned in elongate shaft 12 and/or the end-effector 16 which can beconfigured to support the movable member 36 as the movable member 36 ismoved proximally and/or distally within the end-effector 16. In at leastone such embodiment, the distal end 20 of the elongate shaft 12 canhouse the first guide 62. In various embodiments, a second guide 64 canbe positioned within the elongate shaft 12 to support the tube 35. Invarious embodiments, the first guide 62 and/or the second guide 64 canalso receive therethrough the conductive element 46 and/or the returnconductive element (not illustrated) which can complete the energycircuit with the electrode or the electrodes of the end-effector 16, asdiscussed in greater detail herein. In at least one embodiment, the tube35 can act as the return conductor for returning energy from the secondelectrode 45.

In one embodiment, again referring to FIGS. 2A-4, 5, 6, and 6A, the fuse33 can be positioned over the electrode 45 of the second jaw 32.Although the fuse 33 is described as being positioned on the second jaw32, it can also be positioned on the first jaw 30 or on both of thefirst jaw 30 and the second jaw 32. In other embodiments, the fuse 33can also be positioned on at least portions of the movable member 36. Asdiscussed above, the fuse 33 can be comprised of a PTC material. As thePTC material increases in temperature, in various circumstances, itselectrical impedance can increase. Thus, the PTC material can becomepower limiting when the temperature of the PTC material rises above adesired level and, thus, the impedance can rise to a level in which theflow of current between the electrodes is substantially reduced. In oneembodiment, if the PTC material is used, a constant energy supply can beused. Examples of the various PTC materials and their functions aredescribed in greater detail in U.S. Pat. No. 5,624,452 to Yates,entitled HEMOSTATIC SURGICAL CUTTING OR STAPLING INSTRUMENT, U.S. Pat.No. 6,929,644 to Truckai et al., entitled ELECTROSURGICAL JAW STRUCTUREFOR CONTROLLED ENERGY DELIVERY, U.S. Pat. No. 6,770,072 to Truckai etal., entitled ELECTROSURGICAL JAW STRUCTURE FOR CONTROLLED ENERGYDELIVERY, and U.S. Pat. No. 6,929,622 to Chian, entitled SAFETY SYRINGECYLINDER, the entire disclosures of which are hereby incorporated byreference. The use of various PTC materials in electrosurgicalinstruments is also described in U.S. Pat. No. 7,112,201 entitledELECTROSURGICAL JAW STRUCTURE FOR CONTROLLING ENERGY DELIVERY and U.S.Pat. No. 6,929,622 entitled ELECTROSURGICAL JAW STRUCTURE FOR CONTROLLEDENERGY DELIVERY, the entire disclosures of which are incorporated hereinby reference.

In one embodiment, temperature measuring devices or sensors, such asthermocouples, RTD's (resistive thermal devices), thermistors, and/orother suitable devices can be embedded at strategic locations within theend-effector 16 to sense the temperature of the tissue positioned withinthe end-effector 16. In certain embodiments, the delivery of energy toat least one of the electrodes can be controlled in response to feedbackfrom these devices, for example.

In one embodiment, the energy source 11 can deliver energy to theconductive element 46, the electrode 44, the electrode 45, and/or areturn conductive element. In various embodiments, the actuation button26 can be operably engaged with a switch to allow the energy to passfrom the energy source 11 to the conductive element 46 and thereby tothe electrode 44 when the actuation button 26 is actuated or depressed.In certain embodiments, energy can flow to the electrode 44 until thebutton 26 is released. In at least one embodiment, the actuation button26 can allow energy to flow to the electrode 44 for a predeterminedsuitable period of time regardless of how long the actuation button 26is depressed by the surgeon. Such a feature can ensure that adequateenergy is supplied to the tissue to create a suitable seal in thetissue. In one embodiment, the predetermined suitable period of time canbe based on the thickness of the tissue clamped within the end-effector16.

In one embodiment, the path of the energy can be from the energy source11, to the conductor 15, through the switch, to the conductive element46, to the electrode 44, through the tissue clamped within theend-effector 16 (i.e., through the first region of the tissue), throughthe fuse 33, to the return electrode 45 (e.g., portions of the secondjaw 32), through a return conductor, through the conductor 17 and backto the energy source 11, thereby completing the circuit of the energysource 11 with the end-effector 16.

In one embodiment, heat can be generated in the end-effector 16 whenelectrical energy is provided to the end-effector 16 during thetissue-sealing process. More particularly, owing to the impedance, orresistance, of the tissue positioned intermediate the electrodes 44 and45 of the end effector 16, heat can be generated within the tissue asthe current is flowing therethrough. As discussed above, such heat candenature the collagen within the tissue positioned intermediate theelectrodes 44 and 45. In various circumstances, however, the heat canspread from the regions of the tissue being sealed between theelectrodes 44 and 45 (i.e., the sealing region) into the tissuesurrounding or adjacent to the region of the tissue being sealed (i.e.,the surrounding region). Such thermal spreading into the surroundingregion may not be desirable in certain circumstances in that the heatcan over-denaturate the collagen in, and/or otherwise damage, thesurrounding tissue. As a result, in some instances, it may be desirableto tension the surrounding tissue in order to reduce the denaturationthereof. Further to the above, tensioning, or applying tensile stressesor loads to, the tissue in the surrounding region of tissue candecrease, or possibly exponentially decrease, the rate at which thethermal damage to the surrounding tissue can occur. More specifically,tensioning the surrounding tissue can decrease, or possiblyexponentially decrease, the amount in which the surrounding tissueshrinks during the sealing process. As such, it may be desirable totension or apply a mechanical stress or load to the surrounding tissueto reduce the rate at which thermal damage occurs in the surroundingtissue.

In view of the above, referring to FIGS. 6 and 6A, the surgicalinstrument 10 of the present disclosure can be configured to tensiontissue (indicated as “T”) surrounding the first region of tissue 72being sealed by the end-effector 16 using the first, second, third,and/or the fourth slider members 50, 52, 66, and 68. In one embodiment,less than all of the first, second, third, and/or the fourth slidermembers 50, 52, 66, and 68 may be used to tension the tissue. In oneembodiment, for example, the first and second slider members 50 and 52can be used to tension the tissue, while in other embodiments, the thirdand fourth slider members 66 and 68 can be used to tension the tissue.In at least one such embodiment, a surgical instrument can comprise afirst movable member which can be displaced distally to actuate thefirst and second slider members 50 and 52 and a second movable memberwhich can be displaced distally to actuate the third and fourth slidermembers 66 and 68 wherein the first movable member and the secondmovable member can be actuated independently.

In one embodiment, referring to FIGS. 4-8, the first slider member 50and the second slider member 52 can be movable laterally relative to thelongitudinal axis defined between the first end of the electrode 44 andthe second end of the electrode 44. In various embodiments, as describedabove, the first slider member 50 and the second slider member 52 canmove relative to and/or away from the electrode 44 in a first directionand the third slider member 66 and the fourth slider member 68 can moverelative to and/or away from the electrode 44 in a second direction. Inone embodiment, as also described above, the first direction can beopposite, or substantially opposite, to the second direction.

In various embodiments, referring to FIGS. 3A-8, the movable member 36can be configured to engage the first jaw 30 and the second jaw 32 whenthe movable member 36 is advanced distally within the end-effector 16 tocompress the first region of the tissue 72. As described above, themovable member 36 can be configured to bias the first slider member 50relative to and/or away from the electrodes 44 and 45 and can beconfigured to bias the second slider member 52 relative to and/or awayfrom the electrode 44 and 45. As also described above, such biasing canbe accomplished by the cams 40 or other members on the distal portion ofthe movable member 36. In one embodiment, the first slider member 50 andthe second slider member 52 can be moveable relative to the axis of theelectrode 44 between a first, unextended position (see e.g., FIGS. 3A,6, and 7) and a second, extended position (see e.g., FIGS. 4, 5, 6A, and8). The first and second slider member 50 and 52 can be further awayfrom the longitudinal axis of the electrode 44 when in the second,extended position than when in the first, unextended position.Similarly, in one embodiment, the third slider member 66 and the fourthslider member 68 can be moveable relative to the axis of the electrode44 between a first, unextended position (see e.g., FIGS. 3A, 6, and 7)and a second, extended position (see FIGS. 4, 5, 6A, and 8). The thirdand fourth slider members 66 and 68 can be further away from thelongitudinal axis of the electrode 44 when in the second, extendedposition than when in the first, unextended position.

In one embodiment, further to the above, the movable member 36 can be acutting member configured to cut the tissue within the first region ofthe tissue 72. The cutting member can be configured to engage the firstjaw 30 and the second jaw 32 when the cutting member is advanceddistally within the end-effector 16 to compress and cut or score thefirst region of the tissue 72. The cutting member can be configured toact against and/or bias the various slider members to move the variousslider members relative to, away from, and/or toward the electrode 44.In such an embodiment, the cutting member can comprise cams, similar tocams 40, described above. Other details of the cutting member'sengagement with the various slider members can be the same as or similarto the engagement of the movable member 36 with the various slidermembers described herein.

In one embodiment, referring to FIGS. 6 and 6A, the electrode 44 and thefuse 33 can engage the first region of tissue 72 compressed (indicatedas “C”) within the end-effector 16 when the second jaw 32 is moved intothe closed position. The first and the second slider members 50 and 52can each comprise a tissue-contacting surface configured to engage thesecond region of the tissue 74. Likewise, the third and fourth slidermembers 66 and 68 can each comprise a tissue-contacting surfaceconfigured to engage the third region of the tissue 76. Upon closure ofthe second jaw 32, the first and second slider members 50 and 52 canengage the second region of the tissue 74 and the third and fourthslider members 66 and 68 can engage the third region of tissue 76. Afirst non-engaged portion of tissue 78 can be present intermediate thefirst region of the tissue 72 and the second region of the tissue 74 anda second non-engaged portion of tissue 80 can be present intermediatethe first region of the tissue 72 and the third region of the tissue 76.In use, the first non-engaged portion of tissue 78 can be tensioned bythe first and second slider members 50 and 52 when they are movedrelative to and/or away from the electrode 44. Stated another way, thefirst and second slider members 50 and 52 can apply a tensile force tothe first non-engaged portion of tissue 78 when they are moved relativeto and/or away from the electrode 44. The second non-engaged portion oftissue 80 can be tensioned by the third and the fourth slider members 66and 68 when they are moved relative to and/or away from the electrode44. Stated another way, the third and fourth slider members 66 and 68can apply a tensile force to the second non-engaged portion of tissue 80when they are moved relative to and/or away from the electrode 44. Inone embodiment, this tensioning can occur by the cams 40, or otherstructures, of the movable member 36 engaging the various slider membersand moving them relative to and/or away from the electrode 44 and thefuse 33, and/or relative to and/or away from the longitudinal axis ofthe electrode 44 and/or the end-effector 16. The cams 40 can engage thevarious slider members when the movable member 36 is advanced proximallyto distally within the end-effector 16 when the trigger 24 is retracted.In one embodiment, the trigger 24 can be retracted more than one time tofully advance the movable member 36.

When energy is supplied by the energy source 11 to the electrode 44 onthe first jaw 30, the energy can pass through the first region of thetissue 72 and then flow through the fuse 33 to the electrode 45 on thesecond jaw 32. This passage of energy through the first region of tissue72 can generate heat within the first region of the tissue 72 which heatcan extend toward, to, or beyond the second region of tissue 74 and/orthe third region of tissue 76. As such, the heat can also extend intothe first non-engaged portion of the tissue 78 and the secondnon-engaged portion of the tissue 80, for example, and then outwardlytherefrom. Tensioning of the first and second non-engaged portions ofthe tissue 78 and 80 can reduce the spread of thermal damage from thefirst region of tissue 72 as the rate of thermal damage at a giventemperature is reduced in the presence of increased tensile stresseswithin the tissue. In one embodiment, the tensioning of the first andsecond non-engaged portions of the tissue 78 and 80 can reduce thespread of thermal damage beyond the second and third regions of tissue74 and 76, for example.

As described above, referring to FIGS. 4-5, some or all of the first,second, third, and fourth slider members 50, 52, 66, and 68 can comprisea camming surface which can be engaged by a cam extending from themovable member 36, for example. In at least one embodiment, the firstslider member 50 can comprise a first camming surface 90 and the secondslider member 52 can comprise a second camming surface 92 (FIG. 2A)wherein a channel 94 can be defined intermediate the first cammingsurface 90 and the second camming surface 92. In at least one suchembodiment, a cam track 96 can extend along one or both sides of thechannel 94. Similarly, the third slider member 66 can comprise a firstcamming surface 90 and the fourth slider member 68 can comprise a secondcamming surface 92 wherein a channel 94 can be defined intermediate thefirst camming surface 90 and the second camming surface 92. In at leastone such embodiment, a cam track 96 can extend along one or both sidesof the channel 94. In use, as described in greater detail below, thecams 40 of the movable member 36 can be movably received within thechannels 94 as the movable member 36 is moved distally.

Further to the above, the various slider members of the end-effector 16can be in their first, unexpanded position prior to the end-effector 16being closed. When the trigger 24 is retracted to advance the movablemember 36 distally within the end-effector 16, the cams 40 can engageand move along the channels 94 and contact the first camming surfaces 90and the second camming surfaces 92. Through contact with the cammingsurfaces and the distal movement of the movable member 36, the variousslider members can be moved relative to and/or away from the electrodes44 and 45, relative to and/or away from the longitudinal axis of theend-effector 16, and/or relative to and/or away from the cutting memberslots 60 and 60′. Such movement can cause the various slider members totension the first and second non-engaged portions of the tissue 78 and80 and reduce the spread of thermal damage outside of the first andsecond non-engaged portions of tissue 78 and 80. As the cams 40 progressdistally within the end-effector 16, they can engage the cam tracks 96to maintain the various slider members in the second, expanded position(i.e., the tensioned position). In various circumstances, the biasingmembers 56 and 56′ can limit the displacement of the slider members toassure that the slider members are not over-extended, or moved too faraway from the first region of tissue 72, as the over tensioning of thetissue could possibly tear the first and second non-engaged portions ofthe tissue 78 and 80, for example.

In at least one embodiment, after the movable member 36 has beensufficiently advanced and the first region of tissue 72 has beensufficient sealed and incised, a release button (not illustrated) on thehandle portion 22 can be depressed to allow the movable member 36 tomove proximally with respect to the end-effector 16. While the movablemember 36 is being moved proximally, the cams 40 can move proximallyalong the cam tracks 96 of the various slider members until the cams 40are sufficiently disengaged from the first camming surfaces 90 and thesecond camming surfaces 92. Thereafter, the biasing member 56 of thefirst jaw 30 can pull the first slider member 50 and the third slidermember 66 inwardly toward one another and, similarly, the biasing member56′ of the second jaw 32 can pull the second slider member 52 and thefourth slider member 68 inwardly toward one another. In suchcircumstances, the various slider members can move relative to and/ortoward the electrodes 44 and 45 and/or relative to and/or toward thelongitudinal axis of the end-effector 16 and return the slider membersto their first, or unexpanded, position (see e.g., FIG. 3A).

In certain alternative embodiments, further to the above, only the firstand second slider members 50 and 52 may be movable relative to and/oraway from the electrode 44 such that only the first non-engaged portion78 is tensioned upon the distal movement of the movable member 36 withinthe end-effector 16. In such an embodiment, the end-effector may notcomprise the third and fourth slider members 66 and 68, but instead, theend-effector may comprise third and fourth fixed members. In otherembodiments, the cams 40 may not be provided on one side of the movablemember 36 such that the third and fourth slider members 66 and 68 arenot moved into their second, expanded position upon distal movement ofthe movable member 36 within the end-effector 16. In other embodiments,only the third and fourth slider members 66 and 68 may be movablerelative to, away from, and/or toward the electrode 44 to tension thesecond non-engaged portion of tissue 80.

In one embodiment, referring to FIGS. 7-10, schematic top viewillustrations of the various tissue cutting, sealing, and tensioningsteps undertaken by the end-effector 16 are provided. Not all of thecomponents of the end-effector are shown in FIGS. 7-10 for clarity inillustration. FIG. 7 illustrates the end-effector in a closed positionwherein the various slider members of the end effector are in the first,unextended position. The tissue compression points 82 and 84 of thevarious slider members are illustrated proximate to the electrode 44.The tissue compression point 82 can be between a tissue-contactingsurface of the first slider member 50 and the second slider member 52and the tissue compression point 84 can be between a tissue-contactingsurface of the third slider member 66 and the fourth slider member 68(see e.g., FIGS. 6 and 6A). Arrows “A” indicate one possible directionof movement of the tissue compression points 82 and 84 relative to theelectrode 44 to tension the first and second non-engaged tissue portions78 and 80. FIG. 8 illustrates the end-effector in a closed position withthe various slider members in their second, extended position and thecutting member 38 and the movable member 36 advanced distally within theend-effector. Arrows “B” indicates one possible direction in which thevarious slider members tension the first and second non-engaged portionsof the tissue 78 and 80. FIG. 9 illustrates energy, such as Rf energy,for example, being applied to the first region of the tissue 72contacting the electrode 44 and heat (“H”) spreading from the firstregion of the tissue 72. In FIG. 9 the cutting member 38 and the movablemember 36 continue to be advanced distally within the end-effector. FIG.10 illustrates the tissue after it has been tensioned, sealed, and cut,for example. The seal is indicated as 86 and the cut line is indicatedas 88.

In one embodiment, although not illustrated, the end-effector 16 can beconfigured to deploy staples and/or other permanent fasteners, forexample, into the first region of the tissue 72 and/or any othersuitable region of tissue. It is also conceived that these fasteners maybe made of an absorbable or dissolvable material such as Vicryl and/oriron, for example. Other materials could include PDS, PLA, and/or anyother suitable polymer and/or magnesium and/or any other suitable metal,for example. In various embodiments, the movable member 36 can comprisea staple driver on a distal end or portion thereof, for example. Thefirst jaw 30 can be configured to receive a staple cartridge comprisingone or more staples or rows of staples and the second jaw 32 cancomprise one or more anvil pockets or rows of anvil pockets configuredto receive the legs of one or more staples therein to deform the staplesas they are deployed. The anvil pockets can be aligned with staplecavities in the staple cartridge such that the staple legs can bedeformed when the staples are deployed from the staple cartridge. In oneembodiment, the staples can be fired or deployed from the staplecartridge using the staple driver. In various embodiments, the stapledriver can be energized by the energy source 11, or another energysource such that, when the staple driver contacts the one or morestaples, the staples can be energized to form a seal in the tissue wherethe staple legs puncture the tissue. In such an embodiment, the staplesand the staple driver can comprise electrically conductive materials. Invarious embodiments, the electrode 45 on the second jaw 32 can act asthe return electrode such that energy can flow from the staples, throughthe fuse 33, to the electrode 45 and then be returned to the energysource 11.

In various embodiments, the cutting member 38 and/or portions of themovable member 36 can be energized by the energy source 11, for example,such that as the cutting member 36 cuts the first region of tissue 72,as described above, a seal can be created at the edges of the cut line.Here, the energy from the cutting member 38 can pass through the tissue,to the fuse 33, to the electrode 45, and back to the energy source 11.In various embodiments, as described above, the flow of current throughthe tissue can be controlled by the actuator button 26 which can beactuated before, during, and/or after the tissue is tensioned asdescribed herein.

As discussed above, a surgical instrument can comprise an end effectorwhich can be configured to clamp and compress tissue captured within theend effector and then spread or stretch the tissue laterally in order tocreate tension within the tissue outside the desired region to besealed. As also discussed above, creating tension within the tissue canreduce the rate at which thermal damage occurs, for example, through thetensioned tissue and, as a result, the spread of thermal tissue damagecan be controlled. In various embodiments, a surgical instrument cancomprise an end effector configured to stretch the tissue capturedtherein in any suitable direction. Referring now to FIGS. 11 and 12, asurgical instrument can comprise an end effector 116 which can comprise,similar to the above, a first jaw 100 and a second jaw 102 wherein thesecond jaw 102 can be rotated, or pivoted, relative to the first jaw 100between open and closed positions, for example. In at least one suchembodiment, the surgical instrument can further comprise a movablemember 136 which can be displaced distally to contact the second jaw 102and pivot the second jaw 102 downwardly. Thereafter, the movable member136 can be advanced through the longitudinal slots 160 and 160′ definedin the first jaw 100 and the second jaw 102, respectively, and incisethe tissue captured between the first jaw 100 and the second jaw 102. Invarious embodiments, as described in greater detail below, the distaladvancement of the movable member 136 can cause portions of the endeffector 116 to be displaced distally and, as a result, stretch ortension the tissue longitudinally.

Referring now to FIGS. 13A-13D, a surgical instrument can furthercomprise a handle 114 and, in addition, a shaft 112 extending from thehandle 114. Similar to the above, the handle 114 can comprise a handleportion 122 and a firing trigger 124 operably coupled with the movablemember 136. In at least one such embodiment, the firing trigger 124 canbe pivotably coupled to the handle portion 122 such that the rotation ofthe trigger 124 toward the handle portion 122 can move a top portion ofthe firing trigger 124 distally. In various embodiments, the top portionof the firing trigger 124 can be operably coupled with a firing member130 such that the distal movement of the top portion of the firingtrigger 124 is transmitted to the firing member 130. In suchembodiments, the movable member 136 can be coupled to the firing member130 wherein, as a result, the firing member 130 and the movable member136 can be moved distally when the trigger 124 is retracted toward thehandle portion 122. Referring primarily to FIG. 13A, the firing member130 and the movable member 136 can be slidably positioned within a frame110 of the shaft 112. In at least one such embodiment, the frame 110 cancomprise an inner side wall 111 which can define an inner longitudinalcavity. In various embodiments, at least a portion of the firing member130 and/or the movable member 136 can be closely received within theinner longitudinal cavity such that the firing member 130 and themovable member 136 are confined to movement along a longitudinal pathdefined by the inner side wall 111.

Further to the above, the surgical instrument can be operated through aseries of stages between an open, unfired configuration (FIG. 13A) and aclosed, fired configuration (FIG. 13D). With regard to FIG. 13A, thefiring trigger 124 is illustrated in an unactuated position and themovable member 136 is illustrated in a fully retracted, proximalposition indicated by the proximal datum P. As the firing trigger 124 ismoved toward the handle 122, referring to FIG. 13B, the trigger 124 canadvance the movable member 136 distally past the datum P and into thelongitudinal slots 160 and 160′ of the jaws 100 and 102, respectively,in order to close the second jaw 102, as described above. The readerwill note that the movable member 136 has only been partially advancedin FIG. 13B and may be returned to its retracted position illustrated inFIG. 13A in order to reopen the second jaw 102. In such circumstances,the movable member 136, and/or any cutting edge on the movable member136, may not contact the tissue captured between the first jaw 100 andthe second jaw 102 when the movable member 136 has only been advanced toits position illustrated in FIG. 13B. The reader will also note, whencomparing FIGS. 13A and 13B, that the firing member 130 is configured tomove relative to the shaft frame 110 when the firing member 130 is movedbetween its positions illustrated in FIGS. 13A and 13B, as described ingreater detail below.

Referring again to FIG. 13A, the firing member 130 can comprise a detentmember 132 which can be positioned within a longitudinal detent slot 113defined in the shaft frame 110. In at least one such embodiment, thefiring member 130 can further comprise a detent spring 131 which can beconfigured to bias the detent member 132 into the longitudinal detentslot 113. In various embodiments, the slot 113 can comprise a proximalend 115 and a distal end 117 wherein the detent member 132 can beconfigured to slide between the proximal end 115 and the distal end 117of the slot 113 when the firing member 130 is advanced between itsposition illustrated in FIG. 13A and its position illustrated in FIG.13B. More particularly, referring to FIG. 13A, the detent member 132 canbe positioned adjacent to the proximal end 115 of the slot 113 when thesurgical instrument is in an unfired position and, referring now to FIG.13B, the detent member 132 can be positioned adjacent to the distal end117 of the slot 113 when the firing member 130 is advanced distally toclose the second jaw 102 as described above. In such circumstances, thedetent member 132 can slide within the longitudinal detent slot 113 ofthe shaft frame 110 which can allow the firing member 130 to moverelative to the shaft frame 110.

In various embodiments, further to the above, portions of the first jaw100 and the second jaw 102 can extend from the shaft frame 110 and,thus, when the shaft frame 110 is moved distally, such portions of thefirst jaw 100 and the second jaw 102 can be moved distally as well.Correspondingly, when the shaft frame 110 is not advanced distally, suchportions of the first jaw 100 and the second jaw 102 can be held inposition. Comparing FIGS. 13A and 13B once again, the reader will notethat the distal end of the first jaw 100, for example, is aligned withdistal datum D in both FIG. 13A and FIG. 13B indicating that neither thefirst jaw 100 nor portions of the first jaw 100 were advanced distallywhen the firing member 130 and the movable member 136 were advanceddistally to close the second jaw 102. Similarly, referring now to FIG.15A, the distal end of the second jaw 102 can remain aligned with thedistal datum D when the firing member 130 and the movable member 136 areadvanced distally to close the second jaw 102. Referring now to FIG.15B, once the firing member 130 has been advanced to close the secondjaw 102 and the detent member 132 contacts the distal end 117 of theslot 113, the subsequent distal movement of the firing member 130 canadvance the shaft frame 110, and portions of the first jaw 100 and/orthe second jaw 102 distally, as described in greater detail below.

Referring to FIG. 13B, further to the above, the detent element 132 canbe moved against the distal end 117 of the slot 113 as the second jaw102 is moved into its closed position by the firing member 130 and themovable member 136. Further movement of the firing trigger 124 towardthe handle portion 122 can further advance the firing member 130 and themovable member 136 distally. More particularly, a longitudinal forceapplied to the firing member 130 by the firing trigger 124 can betransmitted to the shaft frame 110 via the detent member 132 such that,as the firing member 130 is advanced distally, the shaft frame 110 canbe advanced distally as well. In such circumstances, the detent member132 can be at least partially positioned within a guide slot 133 definedin the firing member 130 and, in addition, at least partially positionedagainst the distal end 117 of the longitudinal slot 113 such that thelongitudinal force applied to the firing member 130 can be transmittedto the detent member 132 through a sidewall of the guide slot 133 and tothe shaft frame 110 through the interaction of the detent member 132 andthe distal end 117 of the longitudinal slot 113. In various embodiments,the surgical instrument can further comprise a detent lock which can beconfigured to hold the shaft frame 110 in position until a sufficientlongitudinal force has been applied to the shaft frame 110 by the detentmember 132, as described in greater detail below.

Further to the above, referring to FIGS. 13A and 13B, the shaft frame110 can further comprise a detent member 128 movably positioned within aguide slot 119 defined in the shaft frame 110 wherein the detent member128 can be biased into a lock notch 123 defined in the frame 126 of thehandle assembly 114 by a spring 121. In various embodiments, the locknotch 123 can be defined by a proximal wall 125 and a distal wall 127which can be configured to contain the detent member 128 therebetweenand hold the shaft frame 110 in position until a sufficient force isapplied to the shaft frame 110 to push, or recess, the detent member 128into the guide slot 119 defined in the shaft frame 110 and allow theshaft frame 110 to slide distally relative to the handle frame 126 asdescribed above. In at least one such embodiment, at least a portion ofthe detent member 128 can be positioned within the guide slot 119 and,in addition, at least a portion of the detent member 128 can bepositioned within the lock notch 123 such that the longitudinal forceapplied to the shaft frame 110 can be transmitted through a sidewall ofthe guide slot 119, to the detent member 128, and to the distal wall 127of the lock notch 123 which can create a reactionary force between thedistal wall 127 and the detent member 128 which pushes the detent member128 into the guide slot. In various embodiments, the detent member 128can comprise an inclined, conical, and/or curved surface, for example,which can be configured to displace the detent member 128 into the guideslot. In any event, the biasing spring 121 can comprise a springstiffness sufficient to hold the detent member 128 in the lock notch 123until a predetermined longitudinal force is applied to the shaft frame110 wherein, once this predetermined longitudinal force has beenexceeded, the entirety of the detent member 128 can be pushed out of thelock notch 123 into the guide slot 119 and the shaft frame 110 can bedisplaced distally.

Once the detent lock holding the shaft frame 110 to the handle frame 126has been depressed, or deactivated, in various circumstances, the firingmember 130, the movable member 136, and the shaft frame 110 can beadvanced distally together, as illustrated in FIG. 13C. As discussedabove, portions of the first jaw 100 and/or the second jaw 102 can bemounted to the shaft frame 110 wherein, as a result, such portions ofthe first jaw 100 and/or the second jaw 102 can be moved distally withthe shaft frame 110. In at least one embodiment, referring again toFIGS. 11 and 12, the first jaw 130 can comprise a first jaw frame 150which can be mounted to the shaft frame 110. In various embodiments, thefirst jaw frame 150 can comprise a trough 140 which can be configured toreceive at least a portion of an electrode 144 and/or an electrodesupport 148 therein. In at least one such embodiment, the electrode 144,the electrode support 148, and/or the trough 140 can be substantiallyU-shaped wherein, in at least one embodiment, the trough 140 cancomprise an enlarged distal portion 141 which can be configured topermit relative longitudinal movement between the electrode 144 and thefirst jaw frame 150. Referring again to FIGS. 13B and 13C, the first jawframe 150, as it is mounted to the shaft frame 110, can be moveddistally when the shaft frame 110 is moved distally. In at least onesuch embodiment, the distal end of the first jaw frame 150 can be movedfrom a position (FIG. 13B) indicated by distal datum D to a position(FIG. 13C) in which the distal end of the first jaw frame 150 ispositioned distally with respect to distal datum D. Upon comparing FIGS.13B and 13C, the reader will note that neither the electrode 144 nor theelectrode support 148 has been advanced distally with the first jawframe 150. In such an embodiment, the electrode 144 and/or the electrodesupport 148 can be mounted to a non-movable inner frame extendingthrough the shaft 112, for example. In at least one embodiment,referring to FIG. 12, the electrode support 148 can comprise a retentionmember 149 extending therefrom which can be engaged with the non-movableinner frame to prevent the electrode support 148, and the firstelectrode 144 supported within a channel 158 defined in the electrodesupport 148, from moving longitudinally.

Similar to the above, the second jaw 102 can comprise a portion thereofwhich is mounted to the shaft frame 110 and advanced distally when theshaft frame 110 is advanced distally. In various embodiments, referringagain to FIGS. 11 and 12, the second jaw 102 can comprise a second jawframe 151, a second electrode 145, and a second electrode support 147.In at least one such embodiment, also similar to the above, the secondjaw frame 151 can be mounted to the shaft frame 110 while the secondelectrode 145 and the second electrode support 147 can be mounted to thenon-movable inner frame extending through the shaft 112. In use,referring to FIG. 15A, the distal end of the second jaw frame 151 can bealigned with the distal datum D before the shaft frame 110 is advanceddistally wherein, referring to FIG. 15B, the distal end of the secondjaw frame 151 can be positioned distally with respect the distal datum Dafter the shaft frame 110 has been advanced. In certain embodiments,referring again to FIG. 12, the electrode support 148 can be retained tothe second jaw frame 151 by a retention clip 154 which can, one, holdthe electrode support 148 to the second jaw frame 151 when the secondjaw 102 is rotated between open and closed positions and, two, allow thesecond jaw frame 151 to slide distally relative thereto. In at least onesuch embodiment, the retention clip 154 can comprise a retention member159 extending therefrom which can be engaged with the inner shaft frameto permit the rotation of, but prevent the longitudinal displacement of,the clip 154.

As discussed above, the longitudinal displacement of various portions ofthe first jaw 100 and the second jaw 102 can create tension within thetissue. To create such tension, in various circumstances, a portion ofthe jaws 100 and 102 can compress and hold a portion of the tissue in astationary, or at least substantially stationary, position while, at thesame time, a different portion of the jaws 100 and 102 can compress andpull another portion of the tissue distally, for example. In variousembodiments, referring to FIGS. 11 and 12 once again, a portion of thetissue can be compressed between the first electrode 144 and the secondelectrode 145 and, as the electrodes 144 and 145 are not displaceddistally in this embodiment, the tissue compressed between theelectrodes 144 and 145 can be held in a stationary, or at leastsubstantially stationary, position. In at least one such embodiment, thefirst and second jaws 100 and 102 can comprise outer compressionsurfaces which are configured to compress the tissue along the outeredges of the jaws 100 and 102, for example. In certain embodiments, thefirst jaw frame 150 of the first jaw 100 can comprise a first lateralcompression surface 190 and the second jaw frame of the second jaw 102can comprise a second lateral compression surface 192 which, when thesecond jaw 102 is moved into a closed position, can be positionedopposite the first lateral compression surface 190 in order to compresstissue therebetween. In various embodiments, the first jaw frame 150 canfurther comprise a third lateral compression surface 196 and the secondjaw frame 151 can further comprise a fourth lateral compression surface198 which, when the second jaw 102 is moved into a closed position, canbe positioned opposite the third lateral compression surface 196 inorder to compress tissue therebetween. As the first jaw frame 150 andthe second jaw frame 151 are displaced distally with the shaft frame110, as described above, the portion of the tissue captured between thelateral compression surfaces 190 and 192 and the portion of the tissuecaptured between the lateral compression surfaces 196 and 198 can bepulled distally relative to the tissue held in place by the electrodes144 and 145. In such circumstances, some of the tissue captured withinthe end effector 116 can be stretched or tensioned which can provide thebenefits described herein.

As described above, the longitudinal stretching of the tissue can occuras the drive member 130, the movable member 136, and the shaft frame 110are displaced distally together. As the reader will note when comparingFIGS. 13B and 13C, the first jaw frame 150 and the movable member 136have moved in concert with one another, i.e., they have been moved thesame, or at least substantially the same, distance distally. In variouscircumstances, the first jaw frame 150, the second jaw frame 151, andthe movable member 136 can be advanced distally until a portion of theshaft frame 110 contacts the frame 126 of the handle assembly 114, asillustrated in FIG. 13C. In various embodiments, the shaft frame 110 cancomprise a distal stop 129 which can be configured to abut the handleframe 126. At such point, the first jaw frame 150 and the second jawframe 151 may have reached the end of their displacement stroke and maynot be displaced further distally and, correspondingly, the tissuecaptured between the first jaw 100 and the second jaw 102 may not befurthered tensioned. Although the first and second jaw frames 150 and151 may have reached the end of their stroke when the shaft frame 110contacts the handle frame 126, the reader will note that the movablemember 136 may have not yet completed its full firing motion to transectthe tissue captured between the first jaw 100 and the second jaw 102. Insuch circumstances, the firing member 130 and the movable member 136 canbe configured to uncouple from the shaft frame 110 such that the firingmember 130 and the movable member 136 can move relative to the shaftframe 110 and complete the firing motion of the movable member 136, asillustrated in FIG. 13D.

In order to permit the firing member 130 and the movable member 136 tobe advanced distally relative to the shaft frame 110, as describedabove, the detent member 132 can abut the distal end 117 of the slot 113and, in response to the longitudinal force applied the firing member 130by the firing trigger 124, the detent member 132 can be depressedinwardly into the guide slot 133 defined in the firing member 130. Insuch circumstances, the detent member 132 can slide out of thelongitudinal detent slot 113 and slide relative to the shaft frame 110.In at least one such embodiment, the detent member 132 can comprise aninclined, conical, and/or curved surface, for example, which can beconfigured to bias the detent member 132 into the guide slot 133 whenthe detent member 132 abuts the distal end 117 of the longitudinal slot133. As the detent member 132 is biased inwardly, the detent member 132can compress the spring 131 positioned intermediate the detent member132 and a base of the guide slot 133. Once the detent has beendeactivated, the firing trigger 124 can be moved toward the handleportion 122 until the firing trigger 124 has reached itsfully-retracted, fully-fired position. The reader will note from theabove that the longitudinal force applied to the firing member by thetrigger 124 can deactivate detent 128 and 132. Thus, springs 121 and131, respectively, must be carefully selected such that detent 128 isdeactivated before detent 132. In at least one such embodiment, thespring 131 can comprise a higher spring stiffness than the spring 121,for example. This order of release may also be accomplished by adjustingthe amount of interference within each detent.

The full retraction of the firing member can advance the movable member136 distally until the distal end of the movable member 136 has reachedthe distal end of the slots 160 and 160′ defined in the jaws 100 and102, as illustrated in FIG. 13D. In various other circumstances, thesurgeon may not desire to make a full incision and may, as a result,only partially close the firing trigger 124. Whether or not the surgeondecides to fully or only partially advance the movable member 136, thesurgeon can release the trigger 124 to allow the trigger 124 to returnto an unactuated position. In at least one such embodiment, the surgicalinstrument can comprise a trigger spring, for example, which can beconfigured to bias the trigger 124, the firing member 130, and themovable member 136 into an unfired position (FIG. 13A). In certainembodiments, the surgical instrument can comprise a deactivatableretraction lock which can be configured to prevent the retraction of thefiring member 130 and the firing member 136 until the retraction lock isdeactivated.

When the firing trigger 124 is released, further to the above, thefiring trigger 124 can be rotated forward, or away from the handleportion 122. In such circumstances, the top portion of the firingtrigger 124 can be rotated proximally and, owing to the operativeengagement between the top portion of the firing trigger 124 and thefiring member 130, the firing member 130 can be retracted proximally aswell. The retraction motion applied to the firing member 130 can betransmitted to the movable member 136 such that the firing member 130and the movable member 136 can be retracted together. As movable member136 is retracted, the fins 37 of the movable member can be disengagedfrom the first jaw 100 and the second jaw 102 which can allow the secondjaw 102 to be re-opened to release the tissue. In at least one suchembodiment, a jaw spring can be configured to bias the second jaw 102into an open configuration. At some point during the retraction offiring member 130, the detent member 132 can be realigned with thelongitudinal detent slot 113 defined in the shaft frame 110. In suchcircumstances, the detent spring 131 can bias the detent member 132 intothe detent slot 113 wherein further retraction of the firing member 130can position the detent member 132 against the proximal wall 115 of thedetent slot 113. Similar to the above, the detent member 132 cantransmit a longitudinal force between the firing member 130 and theshaft frame 110 such that the firing member 130 can drive the shaftframe 110 proximally as the firing member 130 is retracted. When theshaft frame 110 is moved proximally, the first jaw frame 150 and thesecond jaw frame 151 can be retracted proximally to their unextendedpositions and, at some point during the retraction of shaft frame 110,the detent member 128 can be realigned with the lock notch 123 definedin the handle frame 126. In such circumstances, the detent spring 121can bias the detent member 128 into the lock notch 123 and complete theresetting process of the surgical instrument.

Referring again to FIGS. 15A and 15B, as discussed above, the first jawframe 150 of the first jaw 100 and the second jaw frame 151 of thesecond jaw 102 can be moved distally relative to the electrodes 144 and145 in order to stretch or tension the tissue captured between the firstjaw 100 and the second jaw 102. In certain alternative embodiments, aportion of the first jaw and/or the second jaw can be moved proximallyin order to stretch or tension the tissue. In various embodiments,referring now to FIGS. 16A and 16B, a surgical instrument can comprisean end effector 216 can comprise a first jaw 200 and a second jaw 202wherein, similar to the above, the second jaw 202 can be rotatedrelative to the first jaw 200 between open and closed positions. Alsosimilar to the above, the first jaw 200 can comprise a first jaw frame250 and a first electrode 244 and the second jaw 201 can comprise asecond jaw frame 251 and a second electrode 245. Unlike the embodimentdescribed above, however, the first jaw frame 250 and the second jawframe 251 may not be extendable distally. In at least one suchembodiment, the first electrode 244 and the second electrode 245 can bemoved from a first, or proximal, position (FIG. 16A) to a second, ordistal, position (FIG. 16B). Upon comparing FIG. 16A and FIG. 16B, thereader will note that the distal ends of the electrodes 244, 245 arealigned with distal datum D in their unextended position (FIG. 16A) andextend distally with respect to the distal datum D in their extendedposition (FIG. 16B). The reader will also note when comparing FIGS. 16Aand 16B that the jaw frames 250 and 251 are not extended distally andremain aligned with datum DD when the electrodes 244 and 245 areadvanced.

Referring now to FIGS. 14A and 14B, further to the above, the first jaw200 can further comprise a first electrode support 248 positioned withinthe first jaw frame 250 which can be configured to support the firstelectrode 244. Similarly, the second jaw 202 can further comprise asecond electrode support 247 positioned within the second jaw frame 251configured to support the second electrode 245. In at least one suchembodiment, the second jaw 201 can further comprise a clip 254configured to hold the second electrode support 247 to the second jawframe 251. In use, the second jaw 201 can be moved into a closedposition in which the second electrode 245 contacts the tissuepositioned intermediate the first jaw 200 and the second jaw 202 andcompresses the tissue against the first electrode 244. The region oftissue compressed between the first electrode 244 and the secondelectrode 245 is indicated as tissue region 272. Similar to the above,the second jaw frame 251 can comprise a tissue clamping portion 292which can be positioned opposite a tissue clamping portion 290 of thefirst jaw frame 250 when the second jaw 201 is rotated into a closedposition. In at least one such embodiment, a region of tissue 274defined along the outer perimeter of the first jaw 200 and the secondjaw 202 can be compressed between the tissue clamping portions 290 and292. Also similar to the above, the second jaw frame 251 can comprise atissue clamping portion 298 which can be positioned opposite a tissueclamping portion 296 of the first jaw frame 250 when the second jaw 202is rotated into a closed position. In at least one such embodiment, aregion of tissue 276 defined along the outer perimeter of the first jaw200 and the second jaw 202 can be compressed between the tissue clampingportions 290 and 292.

Once the tissue region has been compressed between the electrodes 244and 245 and the tissue regions 274 and 276 have been compressed betweenthe clamping portions 290 and 292 and the clamping portions 296 and 298,respectively, the electrodes 244 and 245 can be moved distally withrespect to the first jaw frame 250 and the second jaw frame 251, asillustrated in FIG. 14B. In such circumstances, the tissue region 272can be pulled distally with respect to the tissue regions 274 and 276 inorder to pull or tension the regions of tissue positioned therebetween,i.e., tissue regions 278 and 280, respectively. In various embodiments,the first electrode 244 can be moved distally by the first electrodesupport 248 wherein the first electrode support 248 can be configured toslide within a trough or channel defined in the first jaw frame 250.Similarly, the second electrode 245 can be moved distally by the secondelectrode support 247 wherein the second electrode support 247 can beconfigured to slide within a trough or channel defined in the second jawframe 251. In various embodiments, the first electrode support 248 andthe second electrode support 247 can be operably coupled to the shaftframe 110 of the surgical instrument described above. Similarly, thefirst jaw frame 250 and the second jaw frame 251 can be mounted to arigid shaft frame extending through the shaft 112. In any event, priorto, during, and/or after the tissue regions 278 and 280 have beentensioned, the electrodes 244 and 245 can be utilized to treat thetissue and the movable member 136 can be slid through the knife slots260 and 260′ defined in the first jaw 200 and the second jaw 202,respectively, to transect the tissue.

In various embodiments, referring now to FIG. 17, an end effector of asurgical instrument, such as end effector 316, for example, can comprisea first jaw 300 and a second jaw 302 wherein each jaw 300, 302 cancomprise a plurality of teeth configured to grip the tissue positionedintermediate the first jaw 300 and the second jaw 302. In at least onesuch embodiment, the teeth can be comprised of crests 331 which areseparated by valleys 333 and can be defined in the first jaw frame 350of the first jaw 300 and/or the second jaw frame 351 of the second jaw302, for example.

While the present disclosure has been illustrated by description ofseveral example embodiments and while the example embodiments have beendescribed in considerable detail, it is not the intention of theapplicants to restrict or in any way limit the scope of the appendedclaims to such detail. Additional advantages and modifications may bereadily apparent to those of skill in the art. Furthermore, although theexample embodiments disclosed herein have been described in connectionwith a surgical instrument, other embodiments are envisioned inconnection with any suitable medical device. While this disclosure hasbeen described as having exemplary designs, the disclosure may befurther modified within the spirit and scope of the disclosure. Thisapplication is therefore intended to cover any variations, uses, oradaptations of the disclosure using its general principles. Further,this disclosure is intended to cover such departures from the presentdisclosure as come within known or customary practice in the art towhich this disclosure pertains.

The various embodiments of the present disclosure have been describedabove in connection with cutting-type surgical instruments. It should benoted, however, that in other embodiments, the surgical instrumentsdisclosed herein need not be a cutting-type surgical instrument. Forexample, it could be a non-cutting endoscopic instrument, a grasper, astapler, a clip applier, an access device, a drug/gene therapy deliverydevice, an energy device using ultrasound, RF, laser, etc. In certainembodiments, an ultrasonic instrument can be utilized in accordance withthe embodiments disclosed herein. In one such embodiment, an ultrasonicinstrument can comprise a first portion comprising a handle portionand/or end effector, for example, and a second portion comprisingradiation-sensitive electronics. Various ultrasonic instruments aredisclosed in U.S. Pat. No. 6,063,098, entitled ARTICULATABLE ULTRASONICSURGICAL APPARATUS, which issued on May 16, 2000, the entire disclosureof which is hereby incorporated by reference in its entirety. Althoughthe present disclosure has been described herein in connection withcertain disclosed embodiments, many modifications and variations tothose embodiments may be implemented. For example, different types ofend effectors may be employed. Also, where materials are disclosed forcertain components, other materials may be used. The foregoingdescription and following claims are intended to cover all suchmodification and variations.

The disclosures of the following references are also incorporated byreference herein in their entireties:

-   Heat-induced changes in the mechanics of a collagenous tissue:    Isothermal free-shrinkage. Chen, S. S., Wright, N. T., Humphrey, J.    D., 1997. ASME Journal of Biomechanical Engineering 119, 372-378.-   Heat-induced changes in the mechanics of a collagenous tissue:    Pseudoelastic behavior at 37° C. Chen, S. S., Humphrey, J. D., 1998.    Journal of Biomechanics 31, 211-216.-   Phenomenological evolution equations for heat-induced shrinkage of a    collagenous tissue. Chen, S. S., Wright, N. T., Humphrey, J. D.,    1998b. IEEE Transactions on Biomedical Engineering 45, 1234-1240.-   Time-Temperature Equivalence of Heat-Induced Changes in Cells and    Proteins. Wright, N. T., Chen, S. S., Humphrey, J. D., 1998. ASME    Journal of Biomechanical Engineering 120, 22-26.-   Altered mechanical behavior of epicardium under isothermal biaxial    loading. Wells P. B., Harris J. L., Humphrey J. D. J Biomech. Eng.    2004 August; 126(4):492-7.-   Altered mechanical behavior of epicardium due to isothermal heating    under biaxial isotonic loads. Harris J. L., Wells P. B.,    Humphrey J. D. Biomech. Eng. 2003 June; 125(3):381-8.-   Rate of shrinkage of tendon collagen—heat, entropy and free energy    of activation of the shrinkage of untreated tendon. Effect of acid    salt, pickle, and tannage on the activation of tendon collagen.    Weir, C. E., 1949. Journal of the American Leather Chemists    Association 44, 108-140.-   Reversible and irreversible denaturation of collagen fibers.    Hörmann, H., Schlebusch, H., 1971. Biochemistry 10, 932-937.-   Studies in thermal injury V. The predictability and the significance    of thermally induced rate processes leading to irreversible    epidermal injury. Henriques, F. C., 1947. Archives of Pathology 43,    489-502.-   Thermal modification of collagen. Wall, M. S.; Deng, X. H.;    Torzilli, P. A.; Doty, S. B.; O'Brien, S. J.; Warren, R.    F.; 1999. J. Shoulder Elbow Surg. 1999; 8:339-344.-   Thermally induced shrinkage of joint capsule. Moran, K.; Anderson,    P.; Hutcheson, J.; Flock, S.; 2000. Clinical Orthopaedics and    Related Research; 381:248-255.-   A multi-sample denaturation temperature tester for collagenous    biomaterials. Lee, J. M., Pereira, C. A., Abdulla, D., Naimark, W.    A., Crawford, I., 1995. Med. Eng. Phys. 1995; 17:115-121.-   The effect of thermal heating on the length and histologic    properties of the glenohumeral joint capsule. Hayashi, K., Thabit,    III, G., Massa, K. L., Bogdanske, J. J., Cooley, A. J., Orwin, J.    F., Markel, M. D., 1997. American Journal of Sports Medicine Vol.    25; 1:107-112.-   Thermal modification of connective tissues: Basic science    considerations and clinical implications. Arnoczky, S. P., Aksan,    A., 2000. Journal of the American Academy of Orthopaedic Surgeons    2000; 8:305-313.

The surgical instruments disclosed herein can be designed to be disposedof after a single use, or they can be designed to be used multipletimes. In either case, however, the surgical instruments can bereconditioned for reuse after at least one use. Reconditioning cancomprise any combination of the steps of disassembly of the surgicalinstruments, followed by cleaning or replacement of particular pieces,and subsequent reassembly. In particular, the surgical instruments canbe disassembled, and any number of the particular pieces or parts of thesurgical instruments can be selectively replaced or removed in anycombination. Upon cleaning and/or replacement of particular parts, thesurgical instruments can be reassembled for subsequent use either at areconditioning facility, or by a surgical team immediately prior to asurgical procedure. Those skilled in the art will appreciate thatreconditioning of a surgical instrument can utilize a variety oftechniques for disassembly, cleaning/replacement, and reassembly. Use ofsuch techniques, and the resulting reconditioned surgical instrument,are all within the scope of the present disclosure.

Although the various embodiments of the devices have been describedherein in connection with certain disclosed embodiments, manymodifications and variations to those embodiments may be implemented.For example, different types of end effectors may be employed. Also,where materials are disclosed for certain components, other materialsmay be used. Furthermore, according to various embodiments, a singlecomponent may be replaced by multiple components, and multiplecomponents may be replaced by a single component, to perform a givenfunction or functions. The foregoing description and following claimsare intended to cover all such modification and variations.

Any patent, publication, or other disclosure material, in whole or inpart, that is said to be incorporated by reference herein isincorporated herein only to the extent that the incorporated materialsdoes not conflict with existing definitions, statements, or otherdisclosure material set forth in this disclosure. As such, and to theextent necessary, the disclosure as explicitly set forth hereinsupersedes any conflicting material incorporated herein by reference.Any material, or portion thereof, that is said to be incorporated byreference herein, but which conflicts with existing definitions,statements, or other disclosure material set forth herein will only beincorporated to the extent that no conflict arises between thatincorporated material and the existing disclosure material.

What is claimed is:
 1. An end effector, comprising: a first jawcomprising a first lateral side and a second lateral side; a second jaw,wherein at least one of said first jaw and said second jaw is moveablethrough a range of positions to move the end effector between an openconfiguration and a fully clamped configuration; a proximal portion; adistal portion; a longitudinal slot extending intermediate said proximalportion and said distal portion, wherein said longitudinal slottransects said first jaw between said first lateral side and said secondlateral side and extends distally beyond a portion of said second jaw;and a cutting member movable along said longitudinal slot; wherein saidfirst jaw is expandable laterally relative to said longitudinal slot toapply a tensile force to tissue clamped between said first jaw and saidsecond jaw when the end effector is in the fully clamped configuration.2. The end effector of claim 1, further comprising an electrodepositioned to contact the clamped tissue.
 3. The end effector of claim2, wherein said first jaw comprises a first tissue-gripping portion,wherein said second jaw comprises a second tissue-gripping portion, andwherein said first tissue-gripping portion and said secondtissue-gripping portion are movable laterally relative to saidelectrode.
 4. The end effector of claim 3, wherein said first jaw andsaid second jaw are configured to clamp tissue between said firsttissue-gripping portion and said second tissue-gripping portion.
 5. Theend effector of claim 3, wherein said first jaw comprises a first slidermember comprising said first tissue-gripping portion, and wherein saidsecond jaw comprises a second slider member comprising said secondtissue-gripping portion.
 6. The end effector of claim 5, furthercomprising a biasing member configured to bias said first slider memberand said second slider member toward said longitudinal slot.
 7. An endeffector, comprising: a first jaw comprising a first lateral side, asecond lateral side, and a first width defined intermediate said firstlateral side and said second lateral side; a second jaw comprising asecond width, wherein at least one of said first jaw and said second jawis moveable through a range of positions to move the end effectorbetween an open configuration and a fully clamped configuration; alongitudinal slot, wherein said longitudinal slot transects said firstjaw between said first lateral side and said second lateral side andextends distally beyond a portion of said second jaw; and a cuttingmember movable along said longitudinal slot; wherein said first width ofsaid first jaw and said second width of said second jaw are adaptable toadjust a force applied to tissue clamped between said first jaw and saidsecond jaw when the end effector is in the fully clamped configuration.8. The end effector of claim 7, further comprising an electrodepositioned to contact the clamped tissue.
 9. The end effector of claim8, wherein said first jaw comprises a first tissue-gripping portion,wherein said second jaw comprises a second tissue-gripping portion, andwherein said first tissue-gripping portion and said secondtissue-gripping portion are movable laterally relative to saidelectrode.
 10. The end effector of claim 9, wherein said first jaw andsaid second jaw are configured to clamp tissue between said firsttissue-gripping portion and said second tissue-gripping portion.
 11. Theend effector of claim 9, wherein said first jaw comprises a first slidermember comprising said first tissue-gripping portion, and wherein saidsecond jaw comprises a second slider member comprising said secondtissue-gripping portion.
 12. The end effector of claim 11, furthercomprising a biasing member configured to bias said first slider memberand said second slider member toward said longitudinal slot.
 13. An endeffector, comprising: a first jaw comprising a width, a first lateralside, and a second lateral side; a second jaw, wherein at least one ofsaid first jaw and said second jaw is moveable through a range ofpositions to move the end effector between an open configuration and afully clamped configuration; a longitudinal slot, wherein saidlongitudinal slot transects said first jaw between said first lateralside and said second lateral side and extends distally beyond a portionof said second jaw; and a cutting member movable along said longitudinalslot; wherein said width of said first jaw is configured to change toadjust a pressure in tissue clamped between said first jaw and saidsecond jaw when the end effector is in the fully clamped configuration.14. The end effector of claim 13, wherein said second jaw comprises asecond width, and wherein said second width is configured to change toadjust the pressure in tissue clamped between said first jaw and saidsecond jaw.
 15. The end effector of claim 14, further comprising anelectrode positioned to contact the clamped tissue.
 16. The end effectorof claim 15, wherein said first jaw comprises a first tissue-grippingportion, wherein said second jaw comprises a second tissue-grippingportion, and wherein said first tissue-gripping portion and said secondtissue-gripping portion are movable laterally relative to saidelectrode.
 17. The end effector of claim 16, wherein said first jaw andsaid second jaw are configured to clamp tissue between said firsttissue-gripping portion and said second tissue-gripping portion.
 18. Theend effector of claim 16, wherein said first jaw comprises a firstslider member comprising said first tissue-gripping portion, and whereinsaid second jaw comprises a second slider member comprising said secondtissue-gripping portion.
 19. The end effector of claim 18, furthercomprising a biasing member configured to bias said first slider memberand said second slider member toward said longitudinal slot.